2012-11-15T11:55:06-06:00 2011-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2011-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER 4028276000 2012-11-14 1 JULIE M GERKEN P00400882 4023302660 2011 2016-02-24 21:20:13Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 10435472 0 X WWW.OMAHASENIORCARE.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 11 9 278 15 0 0 208226 338561 10561250 10034375 31236 17011 49966 40755 10850678 10430702 56727 21316 0 0 5512493 4983196 0 0 0 5457553 5467665 11026773 10472177 -176095 -41475 4282736 3523421 2261631 2006322 2021105 1517099 X TO PROVIDE A CONTINUUM OF QUALITY SERVICES AND PROGRAMS FOR SENIORS AND OTHER PERSONS NEEDING SPECIALIZED CARE. 0 1 5490546 21316 6385338 SKILLED NURSING CARE 2100229 1633241 ASSISTED LIVING CARE 1596118 1996309 ALZHEIMER'S ASSISTED LIVING CARE 21315 19487 OTHER SERVICES 21315 19487 9208208 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 17 0 1 278 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 X ROBERT A BLOECHLE 1.00 X X 0 0 0 BETTY G FOSTER PHD 1.00 X X 0 0 0 LOIS HESS 2.00 X X 0 146500 10526 DEBRA L THACKER 2.00 X X 0 135600 24346 JULIE SCHULTZ SELF 1.00 X 0 0 0 PHIL CHRISTENSEN 1.00 X 0 0 0 LYN M HOLLEY 1.00 X 0 0 0 JOHN JEANETTA 1.00 X 0 0 0 NANCY A MCCARTHY 1.00 X 0 0 0 JULIE MONACO 1.00 X 0 0 0 MARC BUTTERFIELD 1.00 X 0 0 0 0 282100 34872 0 0 1 0 HEALTHCARE SERVICES GROUP SUITE 300 3220 TILLMAN DRIVE BENSALEM PA 19020 HSKPG/LNDRY/DIETARY 1250117 REHAB VISIONS NATIONAL THERAPUETIC ASSOC 11623 ARBOR STREET OMAHA NE 68144 REHAB SERVICES 485164 TRI-STATE NURSING PO BOX 3318 SIOUX CITY IA 51102 TEMPORARY NURSING SERVICES 211822 MAXIM HEALTHCARE SERVICES INC 12558 COLLECTIONS CENTER CHICAGO IL 60693 TEMPORARY NURSING SERVICES 117859 4 334918 3643 338561 MEDICARE/MEDICAID PAYM 623000 8173616 8173616 PRIVATE PAY/INSURANCE 623000 1841272 1841272 MISCELLANEOUS INCOME 623000 17291 17291 VENDOR REBATES 623000 2196 2196 10034375 20298 20298 37410 0 37410 37410 37410 1483 4770 -3287 -3287 -3287 CAFETERIA & VENDING RE 623000 3345 3345 3345 10430702 10034375 0 57766 21316 21316 4284572 4020047 264525 297597 279471 18126 401027 376566 24461 713712 713712 33277 33277 29465 29465 2487062 2398350 88712 960386 895152 65234 274879 274879 27940 22706 5234 5262 5227 35 21475 21475 309735 309735 151041 151041 MEDICAL SUPPLIES 277535 277535 BAD DEBT & CHARITY CARE 144991 144991 DUES & SUBSCRIPTIONS 25807 4711 21096 MISCELLANEOUS 5098 5006 92 10472177 9208208 1263969 0 29028 18204 352918 155212 754739 855057 55067 21839 68710 40167 7612444 6266084 1934532 1346360 1087742 1086582 4282736 3523421 761621 605949 1450000 1385000 50010 15373 2261631 2006322 X -24154 -506899 1040000 1040000 1005259 983998 2021105 1517099 4282736 3523421 X -41475 -462531 X X 0 1 1 X 0 X 7334 5621 6198 2983 3643 25779 11663711 10872522 10515986 10561250 10034375 53647844 21361 5687 6289 1893 3345 38575 11692406 10883830 10528473 10566126 10041363 53712198 0 0 0 53712198 99069 97165 80902 79309 57708 414153 99069 97165 80902 79309 57708 414153 11791475 10980995 10609375 10645435 10099071 54126351 0.99230 0.99200 0.00770 0.00800 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154347 154347 5359878 4442119 917759 1948615 1752726 195889 149604 71239 78365 1346360 DEFERRED FINANCING COSTS, NET 77584 BENEFICIAL INTEREST IN PERPETUAL TRUST 983998 THIRD PARTY PAYOR SETTLEMENTS RECEIVABLE 25000 1086582 ACCRUED INTEREST PAYABLE 3421 DUE TO AFFILIATES 11952 15373 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., FLORENCE HOME AND SENIOR HEALTH FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE NOT-FOR-PROFIT CORPORATIONS HAVE EACH RECEIVED A DETERMINATION LETTER THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. UNIMED, INC. IS A TAXABLE CORPORATION. UNIMED, INC. HAS A NET OPERATING LOSS CARRYFORWARD AS OF DECEMBER 31, 2011 AND 2010, AVAILABLE FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2011, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. OPEN TAX YEARS FOR THE ORGANIZATION INCLUDE 2010, 2009, AND 2008. 1 SENIOR HEALTH FOUNDATION 7915 NORTH 30TH STREET OMAHA NE 68112 470709560 501(C)(3) 20174 FINANCIAL ASSISTANCE FOR OPERATIONS 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FLORENCE HOME FOR THE AGED MONITORS THE USE OF GRANTS BY GRANTING FUNDS ONLY TO LOCAL ORGANIZATIONS THAT ARE AFFILIATED THROUGH COMMON MANAGEMENT. 0 0 0 0 0 0 0 0 0 LOIS HESS 0 146500 0 0 0 0 0 3773 0 6753 0 157026 0 0 DEBRA L THACKER 0 135600 0 0 0 0 0 3460 0 20886 0 159946 0 0 PART I, LINE 3 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, COMPENSATES THE OFFICERS OF FLORENCE HOME FOR THE AGED. THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME FOR THE AGED. CHIEF EXECUTIVE OFFICER: LOIS HESS CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. FOR FURTHER EXPLANATION OF THE PROCESS SEE SCHEDULE O. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 FLORENCE HOME DECIDED TO CLOSE FLORENCE HOME ASSISTED LIVING FACILITY ON AUGUST 15, 2011. MOST OF THE RESIDENTS OF FHAL WERE MOVED TO OUR OTHER FACILITIES AT ROYALE OAKS AND HOUSE OF HOPE. THOSE FEW THAT DID NOT MOVE INTO OUR OTHER FACILITIES FOUND HOMES IN OTHER ASSISTED LIVING FACILITIES IN THE OMAHA METRO AREA. FORM 990, PART VI, SECTION B, LINE 11 ONCE THE FORM 990 AND RELATED SCHEDULES HAVE BEEN PREPARED, THE CONTROLLER AND THE CFO WILL REVIEW IT, MAKE ANY CHANGES AND ACCEPT THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE CONTACTED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASK IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE COMMITTEE HAVE REVIEWED AND ACCEPTED THE FORM 990, IT WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE ASKED TO REVIEW AND DISCLOSE ANY CONFLICTS OF INTERESTS THAT THEY MAY HAVE WITH FLORENCE HOME FOR THE AGED OPERATIONS. THEY ARE THEN ASKED TO SIGN A DOCUMENT INDICATING CONFLICTS, IF ANY. THE BOARD CHAIR IS THEN INFORMED OF ANY CURRENT CONFLICTS FOR CONSIDERATION IN FUTURE VOTING MATTERS OF THE BOARD. FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS THAT IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME, COMPENSATES THE OFFICERS OF FLORENCE HOME AND THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME. THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. CHIEF EXECUTIVE OFFICER: LOIS HESS CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. 1. REVIEW AND APPROVAL. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC., PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. 2. USE OF DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDING. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS. AVERAGE HOURS PER WEEK FORM 990, PAGE 7, PART VII, LINE 1A: FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY ACTUAL OFFICERS IT COMPENSATES. THE CEO AND CFO ON THE FLORENCE HOME FOR THE AGED BOARD OF DIRECTORS ARE ACTUALLY EMPLOYEES OF AND COMPENSATED BY MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, AND THEREFORE THE MAJORITY OF THEIR WORK WEEK IS ATTRIBUTED TO WORKING FOR MIDWEST GERIATRICS, INC. THEY ALSO SERVE AS OFFICERS AND BOARD MEMBERS FOR GERIMED, INC., MIDWEST GERIATRICES, INC., ROYALE OAKS HOUSE OF HOPE, AND SENIOR HEALTH FOUNDATION, RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -21,261. IMPAIRMENT LOSS -371,270. SETTLEMENTS & ASSSESSMENTS -70,000. TOTAL TO FORM 990, PART XI, LINE 5: -462,531. FORM 990, PAGE 12, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS, INC ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 PROVIDE ASSISTANCE TO THE ELDERLY. NE 501(C)(3) 7 N/A 0 GERIMED 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES. NE 501(C)(3) 9 N/A 0 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 SUPPORT FLORENCE HOME AND RELATED ORANGIZATIONS THROUGH MANAGEMENT SERVICES. NE 501(C)(3) 11B TYPE II N/A 0 ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 SUPPORT FLORENCE HOME BY SERVICING A FHA-INSURED NON-RECOURSE LOAN. NE 501(C)(3) 11A TYPE I N/A 0 UNIMED 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 0 1 1 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0